A Cross-sectional Study on Pulmonary Hypertension in Patients with Stage 5 Chronic Kidney Disease.

It is well known that chronic kidney disease (CKD) is associated with significant morbidity and mortality, predominantly due to cardiovascular complications. Recent literature report pulmonary hypertension (PH) as a common accompaniment of CKD and in majority of these cases, secondary causes of PH are not evident. In this study, we looked at the prevalence and possible risk factors of PH in stage 5 CKD patients with a special focus on unexplained PH. In this cross-sectional study, 100 stage 5 CKD patients [50 each on maintenance hemodialysis (HD) and conservative management] were included. After baseline investigations participants underwent two-dimensional transthoracic echocardiogram. The routine method of PH diagnosis based on modified Bernoulli's formula was complemented with an alternate method based on pulmonary artery acceleration time (PAAT). Detailed workup for secondary causes was carried out in patients with PH. The prevalence of PH in the study population was 89% (56% mild, 35% moderate, and 9% severe). Asymptomatic left ventricular diastolic and systolic dysfunction were noted in 54% and 20%, respectively. Significant association with PH was found with the duration of CKD, systolic and diastolic Blood pressure, hemoglobin, transferrin saturation, maintenance HD, and dialysis vintage. In sharp contrast to the existing data this study showed a very high prevalence of PH though severe PH was present only in 9%. The inclusion of PAAT-based method enabled the detection of more cases of PH. Further evaluation carried out for common secondary causes did not show significant abnormalities except for a sizeable proportion with asymptomatic left ventricular dysfunction.

Serum IgE Level among Coir Workers with Asthma: A Hospital Based Descriptive Study from Alappuzha, Kerala.

Background: Coir industry provides a major share of occupation to the natives of Alappuzha district of Kerala State, South India. A significant proportion of workers in this industry have been found to have nasobronchial symptoms. A pilot study conducted in our institute, among coir workers revealed that more than 35% of coir workers suffered from nasobronchial allergy and it is directly proportional the years spent in the work field. This study was conducted to find out whether coir worker's asthma is immunologically mediated or not and also to find out the difference if any in the Ig E level between males and females with coir workers asthma. Methods: The study was done as a descriptive study. Coir workers with symptoms suggestive of asthma who attended the outpatient clinic of Government TD Medical College Hospital Alappuzha during 2005-2006 were included in the study. Detailed occupational history was taken using a semi structured interview schedule. Symptom profile of the patients were assessed in detail followed by clinical examination and spirometry. The serum Ig E level was estimated by ELISA technique. Data were entered in MS Excel and statistical analysis was performed with Mann-Whitney U test using SPSS version 16. P value < 0.05 was taken as the cut off point for statistical significance. Results: The total number of patients included in the study was 62 out of which 25 were males and 37 were females. (Mean age: 36 years, Males: 33 years and Females: 38 years). All except one patient showed latent period before developing asthmatic symptoms and it varied from 6 months to 44 years, with a mean of 9.9 years. The latency period was considerably more in males.56 patients (91%) had elevated total serum IgE (mean of 1311 IU). Male patients had a considerably higher value of serum Ig E. Conclusions: The serum IgE levels were found to be higher in coir workers with asthmatic symptoms and hence it is reasonable to believe that coir workers asthma is of largely immunological in origin.

Nasobronchial allergy and pulmonary function abnormalities among coir workers of Alappuzha.

BACKGROUND: Coir is a commercially important natural fiber obtained from the coconut husk. Coir can be woven into strong twine or rope, and is used for padding mattresses, upholstery, etc. Coir industry provides a major share of occupation to the natives of Alappuzha district of Kerala State. It has been noticed earlier that there is increased incidence of nasobronchial allergy among the population involved in this industry. OBJECTIVES: This study was aimed at recognizing the symptomatology and pulmonary functional impairment among symptomatic coir workers. DESIGN: All coir workers who attended our institute over a period of three years were included in the study. Detailed occupational history was taken; symptom profile was studied in detail, clinical examination and pulmonary function tests conducted. RESULTS: Among the 624 symptomatic coir workers selected for this purpose, 64 patients had purely nasal symptoms, while 560 had symptoms of nasobronchial allergy. 357 patients had reversible obstruction on PFT, while 121 had only small airway obstruction. CONCLUSIONS: We conclude that coir work induced nasobronchial allergy and pulmonary function abnormalities. In absence of CT scan and bronchial challenge testing it may be inappropriate to label coir work as occupational hazard. However the present study may be used as thought provoking study to initiate further understanding.